Pacific Quest
Hilo, HI

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Coming Home:
A Conversation With
Dr. Sousa of PQ

"Dr. Souza is easily one of the best wilderness therapists I have ever worked with in regard to clinical skills and communications with both myself and the parents." Educational Consultant, California

Please take a moment to share a bit about yourself...and what brought you to Pacific Quest?
Having been born on O'ahu and coming from several generations of Hawai'i-born Portuguese and Spanish, I've always had a connection to the islands. And while I was raised on the Mainland, including spending my formative years in California, Nevada, and Colorado, and the last 20 years enduring the harsh winters in Minnesota, I knew one day I would return to Hawai'i.

During one of the harshest Minnesota winters in 35 years, I recall sitting in my office, in a suit and tie thinking, "I don't want to do this anymore." Coming from a background in marriage and family therapy, I had considered ecological systems to be an excellent metaphor for how family systems function. I began to imagine that working with natural systems, such as those found in a garden, would be complementary to my family systems training; PQ was the missing link between my systems background and working with families ecologically. I knew it was what I was meant to do. Plus, not only did I get the benefit of returning to my birthplace, I never have to endure another Minnesota winter!

Can you share a bit about your clinical strengths and specific areas of expertise?
I would say my clinical strengths include being able to highlight other people's strengths, including being able to view their perceived "weaknesses" as positives; I can draw a positive connotation on just about any way of being, partly because of my underlying philosophical worldview that we as humans are naturally driven to attempt to be loved, to love, and to be good at something. However, through the confluence of genetics and environment these predilections become obscured and come out "sideways" through what the mental health field might refer to as "maladaptive" or "dysfunctional" ways of being. I would offer that these ways of being are actually quite the opposite: They are very much about adaptation and attempting to function as best one can within a given set of circumstances. The question is more about how these adaptations fit within a larger social milieu. If the answer is "not well", then the challenge becomes dichotomous: Change the person or change the environment. At PQ we have the opportunity to do both, while also being able to work with students' families, who are also comprised of individuals attempting to do the best they can with what they have. This is not to say that dysfunction doesn't exist-it does; but I am more interested in learning how something dysfunctional may at one point have been functional.

Placing a child outside of the home can be an emotionally daunting process for a parent. How do you assist parents with this transition?
As a parent I have such a deep sense of respect and empathy for the families who make the decision to place their child in a treatment environment, far from home. What I generally offer to these families is 1) whatever you're feeling is okay, including a sense of relief that your child is out of the house; this is such an appropriate response to the situation, especially when you consider that most families have been living in a state of hyper-vigilance and anxiety for months, sometimes years; and 2) you now have a chance to press the "reset" button in order to redefine how your family functions and its "new normal". To begin this reset process, I start with the Five Pillars of Health, including taking stock of your nutrition, your sleep, your exercise, your mental health, and your awareness of the mind-body connection. This not only parallels what your child is doing at PQ, it also gives parents something healthy on which to focus the emotionality of the situation.

Can you talk about your therapeutic approach in terms of integrating the family into the treatment process?
The first thought that comes to mind is "How could the family not be integrated?!" That would be like trying to bake a cake without flour. It just couldn't happen; it wouldn't be a cake. Similarly, you cannot affect the individual without the entire system being affected. To illustrate this I often use the analogy of a hanging mobile (the kind you might place above an infant's crib). When you touch one part of the mobile, all the other pieces necessarily respond. Similarly, our students and their respective families are inextricably intertwined, sometimes too much and sometimes not enough. Part of my job is to help them find a sustainable balance between the mutual influence they have on each other by looking at the way they manage separateness and togetherness, two equally important and necessary elements in all relationships. I do this by encouraging each family member to take stock of his/her Five Pillars of Health and by beginning to separate their thoughts/feelings from their son or daughter's thoughts/feelings. In this way individual family members move from being reactive to being "response-able".

How do you define success as it relates to your work with students and families?
So often students and their families have been stuck in family patterns that limit their ability to be anything outside of the roles they play in those patterns. Therefore, I would define success with students and families as the development of a broader and more balanced awareness of themselves and each other; awareness that each family member is a whole person, not just the role they have been playing for the last umpteenth years. I also consider success to be a lifestyle change that includes the Five Pillars of Health. The more each family member lives well and develops congruence between their insides and their outsides, the more response-able they become, and the more likely they are to be successful in achieving their treatment goals.

How do you integrate referring professionals into the process?
A similar response to question #4 comes to mind "How could referring professionals not be integrated?!" Referring professionals not only help sustain our ability to provide our services through the actual referrals they make, they are a direct part of the treatment team. I cannot think of a single referring professional relationship that has not provided invaluable insight or support toward a family's success at PQ. Therefore, I'm usually disappointed if a family does not have an Educational Consultant or similar referring professional because it means I may provide a less complete clinical assessment than I might have had there been a referring professional to use as a sounding board; someone to bounce ideas off of regarding various hypotheses or interventions and the best post-PQ options for students and their families.

Pacific Quest is an outdoor therapeutic program for struggling teens and young adults, located on the Big Island of Hawaii. Their wilderness programs offer a clinical, yet holistic approach to treatment, going beyond traditional wilderness therapy and teaching sustainable life skills.